Healthcare Provider Details

I. General information

NPI: 1760081749
Provider Name (Legal Business Name): HSRE-AHR ZEPHYRHILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38130 PRETTY POND ROAD
ZEPHYRHILLS FL
33540
US

IV. Provider business mailing address

38130 PRETTY POND ROAD
ZEPHYRHILLS FL
33540
US

V. Phone/Fax

Practice location:
  • Phone: 813-779-4501
  • Fax: 813-779-4509
Mailing address:
  • Phone: 813-779-4501
  • Fax: 813-779-4509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PAUL STODULSKI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 248-784-6550